AAPD Reference Manual 2022-2023

ENDORSEMENTS: CLEFT LIP / PALATE / CRANIOFACIAL ANOMALIES

Patients with craniofacial anomalies require dental care throughtout life as a direct result of their condition and as an integral part of the treatment process. A dental home should be established within six months of eruption of the first tooth and no later than 12 months of age. 5 It includes oral health examinations, caries control, and preventive, restorative, and prosthetic dental treatment as needed. Patients should be closely monitored for periodontal disease and anomalies in dentition and eruption. The condition of the developing dentition and supporting tissues, with counseling regarding early oral hygiene and prevention of early childhood caries, is essential. Prosthetic appliances such as an obturator may help to close a fistula or aid in speech. Orthodontic treatment is also an integral part of the habilitative process and often takes place in phases. The skeletal and dental components should be regularly evaluated. When indicated, orthodontic treatment prepares a child for alveolar bone grafting of the cleft maxilla, correcting malocclusions, and jaw surgery. 1 As members of the interdisciplinary team of physicians, dentists, speech-language pathologists, and other allied health profes- sionals, pediatric dentists should provide dental services in close cooperation with their orthodontic, oral and maxillofacial surgery, and prosthodontic colleagues. 1,4 All dental specialists should ensure 1 : 1. Consultation with an appropriate dental specialist should be made for cleft lip taping and or pre- surgical orthopedics including, but not limited to, nasal alveolar molding. A craniofacial orthodontist (or appropriately-trained clinician) who can discuss with the family the types of infant orthopedic services available and the rationale for using infant ortho- pedics prior to initial cleft lip repair is necessary. 2. Dental radiographs, cephalometric radiographs, and other imaging modalities as indicated should be utilized to evaluate and monitor dental and facial growth and development. 3. Diagnostic records, including properly occluded den- tal study models, should be collected at appropriate intervals for patients at risk for developing maloc- clusion or maxillary-mandibular discrepancies. 4. As the primary dentition erupts, the team evaluation should include a dental examination and, if such services are not already being provided, referral to appropriate providers for caries control, preventive measures, restorative care, and space management. 5. Before the primary dentition has completed eruption, the skeletal and dental components should be evalu- ated to determine if a malocclusion is present or developing. 6. Depending upon the specific goals to be accomplished and also upon the age at which the patient is initially evaluated, orthodontic management of the maloc- clusion may be performed in the primary, mixed, or permanent dentition. In some cases, orthodontic treatment may be necessary in all three stages.

7. While continuous active orthodontic treatment from early mixed dentition to permanent dentition should be avoided, each stage of orthodontic therapy may be followed by retention and regular observation. Orthodontic retention for the permanent dentition may extend into adulthood. 8. For some patients with craniofacial anomalies, func- tional orthodontic appliances may be indicated. 9. For patients with craniofacial anomalies, orthodontic treatment may be needed in conjunction with sur- gical correction (and/or distraction osteogenesis) of the facial deformity. 10. Congenitally missing teeth may be replaced with a removable appliance, fixed restorative bridgework, or osseointegrated implants. 11. Patients should be closely monitored for dental and periodontal disease. 12. Prosthetic obturation of palatal fistulae may be necessary in some patients. 13. A prosthetic speech device may be used to treat velopharyngeal inadequacy in some patients. References 1. American Cleft Palate-Craniofacial Association. Param- eters for Evaluation and Treatment of Patients with Cleft Lip/Palate or Other Craniofacial Differences. Chapel Hill, N.C.: The Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Public Health Service, DHHS; January 2018. Grant # MCJ- 425074. Available at: “https://acpa-cpf.org/team-care/ standardscat/parameters-of-care/”. Accessed October 11, 2019. 2. U.S. Department of Health and Human Services. A Report of the Surgeon General: Children with Special Health Care Needs. Rockville, Md.: Office of Maternal and Child Health, U.S. Department of Health and Human Services; 1987. 3. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities. Rockville, Md.: U.S. Department of Health and Human Services, Office of the Surgeon General; 2005. 4. American Cleft Palate-Craniofacial Association Commis- sion on Approval of Teams. Standards for Approval of Cleft Palate and Craniofacial Teams. American Cleft Palate-Craniofacial Association; 2016. Available at: “https://acpa-cpf.org/wp-content/uploads/2017/06/ standards.pdf”. Accessed October 11, 2019. 5. American Academy of Pediatric Dentistry. Policy on dental home. Pediatr Dent 2018;40(6):29-30.

THE REFERENCE MANUAL OF PEDIATRIC DENTISTRY

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